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MUSCULOSKELETAL ULTRASOUND
DIAGNOSTICSONOGRAPHY
MUSC
ULOSKELETA
L ULTRASO
UND
DIAG
NO
STICSO
NO
GRA
PHY
THOMAS B. CLARK
www.mskus.com
Handbook of Diagnostic Ultrasound Table of Contents
Chapter 1 Shoulder
Chapter 2 Elbow
AnteriorBiceps Tendon (short)Biceps Tendon (long)Pectoralis Major TendonDeltoid Muscle
MedialCoracoacromial LigamentSubscapularis Tendon (long)Subscapularis Tendon (short)
SuperiorA-C JointSubacromial Impingement
Rotator CuffRotator Cuff (long)Rotator Cuff (short)Rotator Cuff Interval
PosteriorPosterior Glenohumeral JointSuprascapular Nerve in Infra Spinoglenoid NotchSuprascapular Nerve in Supra Spinoglenoid Notch
LateralLateral Epicondyle (long)Radial Humeral Joint
AnteriorDistal Biceps
MedialUlnar Collateral LigamentMedial EpicondyleUlnar Nerve (short)
PosteriorOlecranon Fossa (long)Olecranon Fossa (short)
Chapter 3 Wrist/HandFlexor
Flexor Carpi RadialisMedian Nerve (short)Median Nerve (long)
ExtensorExtensor CompartmentsDe Quervain’s Syndrome (1st compartment)Scapholunate LigamentTriangular Fibrocartilage Complex
Hand1st CMC Joint
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15-161718
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25-26
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42
Anterior Anterior Tibiofibular Ligament Anterior Talofibular Ligament Deep Peroneal NerveMedial Posterior Tibial Tendon Tibial NerveLateral Peroneus Brevis Sural Nerve (short) Peroneus Longus Tendon (long) Subtalar Joint
Suprapatellar Quadriceps Tendon Suprapatellar Pouch Femoral CondylesInfrapatellar Patellar Tendon (long) Patellar Tendon (short)Medial Patellofemoral Ligament Medial Collateral Ligament (long) Saphenous Nerve Pes Anserine BursaLateral Lateral Collateral Ligament Popliteus Tendon Iliotibial BandPosterior Baker’s Cyst (long) Baker’s Cyst (short) Peroneal Nerve (short)
Anterior Anterior Hip Joint Psoas Tendon Rectus Femoris Tendon Adductor Longus (long) Lateral Femoral Cutaneous NervePosterior Piriformis Obturator Internus Greater Trochanter (short)Spine Sacroiliac Joint Greater Occipital Nerve (short) Greater Occipital Nerve (long)
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525354
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82-8384
85868788
Handbook of Diagnostic Ultrasound Table of Contents
Chapter 4 Hip/Pelvis/Spine
Chapter 5 Knee
Chapter 6 Ankle
Handbook of Diagnostic Ultrasound Table of Contents
Chapter 6 Ankle
Chapter 7 Physics, Knobology, Nomenclature
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9293
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Physics, Knobology, Nomenclature 99
Posterior Achilles Tendon (long) Achilles Tendon (short) Posterior Talotibial JointPlantar Plantar Fascia (long) Plantar Fascia (short)Foot 1st MTP
3
ShoulderBiceps Tendon (Short)
Patient Position:
Doctor Position:
Probe Position:
patient seated on stool (facing US system pre-ferred), affected upper arm aligned with torso and elbow flexed 90 degrees and forearm supi-nated to align long head of biceps with humerus
sonographer seated on stool (facing US sys-tem preferred next to patient) with sonogra-pher slightly elevated from patient (ergonomic)
short axis to biceps tendon within the bicipi-tal groove and then scan caudally short axis slide of probe to the pectoralis major insertion
13
Shoulder Rotator Cuff (Short)
Probe Position:probe place 90 degrees from the rotator cuff long probe position (point probe rather than toward the navel rotate the probe 90 degrees toward the patient’s nose) (rotator cuff in short axis should appear with multiple septum that are present due to the three rotator cuff ten-don sheaths and their central tendon shadows or “wagon wheel” appearance)
Patient Position:seated on stool (backless stool is pre-ferred so to not restrict arm position) with shoulder completely internally rotated and extended (as far as patient can without significant joint pain) as well as elbow flexed so hand can reach possibly to opposite back pocket (pre-ferred shoulder position to expose rotator cuff from acromial shadow)
Doctor Position:sonographer seated on stool (also fac-ing US system preferred next to pa-tient) with sonographer slightly el-evated from patient (ergonomic)
74
Baker’s Cyst (Short)Knee
Probe Position:place the probe long axis to the criss cross of the semimembranosis and the medial gastrocnemius, proceed to rotate the probe 90 degrees short axis to the semimembra-nosis tendon and medial gastrocnemius myotendinous junction (semimembra-nosis appears almost anechoic due to an-isotrophy caused by the acute tendon fi-ber angle as it dives to its tibial insertion)
Patient Position:patient prone with a small bolster or pillow under the ankles
Doctor Position:doctor seated on exam stool on affect-ed side of patient facing the head of the exam table and US system (usually US system on same side table as doctor)
90
Achilles Tendon (Short)Ankle
Probe Position:place the probe short axis over the Achilles tendon at the level of the calcaneal insertion. Short axis lin-ear slide the probe distally to visualize calcaneal spurring and then short axis lin-ear slide the probe proximally (cephalad) visualizing the retrocalcaneal bursa, Kager’s fat pad and myotendinous junction of the soleus as it joins the Achilles (note the “winding” of the Achilles tendon fibers)
Patient Position:
Doctor Position:
patient prone with foot and ankle off the end of the table and foot moderately dorsiflexed
doctor seated on exam stool at the end of exam table and US system on the af-fected side of the exam table
47
Anterior Hip JointHip/Pelvis
Patient Position:
Doctor Position:
Probe Position:
patient supine with pillow un-der patients head but no pil-low or bolster under the knee on the affected side
doctor standing on af-fected side facing head of the patient and US system
probe placed long axis to the neck and head of femur, which is approximately 30 degrees off midline (4 o’clock on right or 8 o’clock on left), on the inguinal fold at the mid point between the pubic symphysis and the ASIS (anterior superior iliac spine)